The proposed study will be conducted to satisfy the dissertation requirement of the DrPH program at Joseph L. Mailman School of Public Health, Division of Sociomedical Sciences, at Columbia University. Using the Medical Expenditures Panel Survey (MEPS), the Community Tracking Survey (CTS), and focus group data the application proposes to define and predict the population that turns down employer sponsored coverage and remains uninsured. The specific aims are as follows: 1. Determine the relative effects of risk aversion and income on the decision to decline employer sponsored health insurance and remain uninsured. 2. Determine if age interacts with risk aversion and income to effect the decision to decline employer sponsored health insurance and remain uninsured throughout the ages of 18 to 64. Using multivariate analysis of MEPS survey data the following hypotheses will be tested: 1) Those who voluntarily decline health insurance and remain uninsured are more likely to have low incomes, controlling for other demographic variables. 2) Those with a lower level of risk aversion will be more likely to voluntarily decline employer sponsored health insurance and remain uninsured. 3) Income and risk aversion with have differential effects on the decision to decline employer- sponsored health insurance and remain uninsured based on age. Based on results from the multivariate analysis, the study will then propose alternative policy options to address this issue and decrease the number of uninsured workers. The policy options section will also employ the results from a series of focus groups with low-wage workers. There were a total of ten groups done in five different cities in February 1999. The study will provide much needed information about this growing proportion of the uninsured. Results from the study could inform the current policy debate on public insurance expansions and improving access to both insurance and health care for low-wage workers.